Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy

Facility

$5,360.10

Service Code	APR-DRG 7723
Hospital Charge Code	APRDRG7721
Min. Negotiated Rate	$5,360.10
Max. Negotiated Rate	$5,360.10
Rate for Payer: AHCCCS Medicaid	$5,360.10
Rate for Payer: Allwell Medicaid	$5,360.10
Rate for Payer: AZCH Complete Medicaid	$5,360.10
Rate for Payer: Banner UC Health Medicaid	$5,360.10
Rate for Payer: Mercy Care Medicaid	$5,360.10

Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy

Facility

$5,360.10

Service Code	APR-DRG 7723
Hospital Charge Code	APRDRG7722
Min. Negotiated Rate	$5,360.10
Max. Negotiated Rate	$5,360.10
Rate for Payer: AHCCCS Medicaid	$5,360.10
Rate for Payer: Allwell Medicaid	$5,360.10
Rate for Payer: AZCH Complete Medicaid	$5,360.10
Rate for Payer: Banner UC Health Medicaid	$5,360.10
Rate for Payer: Mercy Care Medicaid	$5,360.10

Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy

Facility

$4,314.31

Service Code	APR-DRG 7722
Hospital Charge Code	APRDRG7723
Min. Negotiated Rate	$4,314.31
Max. Negotiated Rate	$4,314.31
Rate for Payer: AHCCCS Medicaid	$4,314.31
Rate for Payer: Allwell Medicaid	$4,314.31
Rate for Payer: AZCH Complete Medicaid	$4,314.31
Rate for Payer: Banner UC Health Medicaid	$4,314.31
Rate for Payer: Mercy Care Medicaid	$4,314.31

Alcohol Breath

Facility

$47.00

Service Code	CPT 82075
Hospital Charge Code	22600606
Hospital Revenue Code	301
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

Alcohol Breath

Facility

$47.00

Service Code	CPT 82075
Hospital Charge Code	22600606
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: AHCCCS Medicaid	$17,034.20
Rate for Payer: Allwell Medicaid	$17,034.20
Rate for Payer: AZCH Complete Medicaid	$17,034.20
Rate for Payer: Banner UC Health Medicaid	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: AHCCCS Medicaid	$7,137.45
Rate for Payer: Allwell Medicaid	$7,137.45
Rate for Payer: AZCH Complete Medicaid	$7,137.45
Rate for Payer: Banner UC Health Medicaid	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: AHCCCS Medicaid	$3,475.44
Rate for Payer: Allwell Medicaid	$3,475.44
Rate for Payer: AZCH Complete Medicaid	$3,475.44
Rate for Payer: Banner UC Health Medicaid	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: AHCCCS Medicaid	$7,137.45
Rate for Payer: Allwell Medicaid	$7,137.45
Rate for Payer: AZCH Complete Medicaid	$7,137.45
Rate for Payer: Banner UC Health Medicaid	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: AHCCCS Medicaid	$3,475.44
Rate for Payer: Allwell Medicaid	$3,475.44
Rate for Payer: AZCH Complete Medicaid	$3,475.44
Rate for Payer: Banner UC Health Medicaid	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: AHCCCS Medicaid	$17,034.20
Rate for Payer: Allwell Medicaid	$17,034.20
Rate for Payer: AZCH Complete Medicaid	$17,034.20
Rate for Payer: Banner UC Health Medicaid	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: AHCCCS Medicaid	$4,535.95
Rate for Payer: Allwell Medicaid	$4,535.95
Rate for Payer: AZCH Complete Medicaid	$4,535.95
Rate for Payer: Banner UC Health Medicaid	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: AHCCCS Medicaid	$17,034.20
Rate for Payer: Allwell Medicaid	$17,034.20
Rate for Payer: AZCH Complete Medicaid	$17,034.20
Rate for Payer: Banner UC Health Medicaid	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: AHCCCS Medicaid	$4,535.95
Rate for Payer: Allwell Medicaid	$4,535.95
Rate for Payer: AZCH Complete Medicaid	$4,535.95
Rate for Payer: Banner UC Health Medicaid	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: AHCCCS Medicaid	$3,475.44
Rate for Payer: Allwell Medicaid	$3,475.44
Rate for Payer: AZCH Complete Medicaid	$3,475.44
Rate for Payer: Banner UC Health Medicaid	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: AHCCCS Medicaid	$3,475.44
Rate for Payer: Allwell Medicaid	$3,475.44
Rate for Payer: AZCH Complete Medicaid	$3,475.44
Rate for Payer: Banner UC Health Medicaid	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: AHCCCS Medicaid	$7,137.45
Rate for Payer: Allwell Medicaid	$7,137.45
Rate for Payer: AZCH Complete Medicaid	$7,137.45
Rate for Payer: Banner UC Health Medicaid	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: AHCCCS Medicaid	$17,034.20
Rate for Payer: Allwell Medicaid	$17,034.20
Rate for Payer: AZCH Complete Medicaid	$17,034.20
Rate for Payer: Banner UC Health Medicaid	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: AHCCCS Medicaid	$7,137.45
Rate for Payer: Allwell Medicaid	$7,137.45
Rate for Payer: AZCH Complete Medicaid	$7,137.45
Rate for Payer: Banner UC Health Medicaid	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: AHCCCS Medicaid	$4,535.95
Rate for Payer: Allwell Medicaid	$4,535.95
Rate for Payer: AZCH Complete Medicaid	$4,535.95
Rate for Payer: Banner UC Health Medicaid	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: AHCCCS Medicaid	$4,535.95
Rate for Payer: Allwell Medicaid	$4,535.95
Rate for Payer: AZCH Complete Medicaid	$4,535.95
Rate for Payer: Banner UC Health Medicaid	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95

Alcohol Level

Facility

$312.00

Service Code	CPT 80320
Hospital Charge Code	1279592
Hospital Revenue Code	301
Min. Negotiated Rate	$49.92
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Aetna of AZ Medicare	$87.36
Rate for Payer: Allwell Medicare	$49.92
Rate for Payer: Amerigroup Medicare	$49.92
Rate for Payer: APIPA Medicare/Medicaid	$116.53
Rate for Payer: AZCH Complete Medicare	$49.92
Rate for Payer: Banner UC Health Medicare	$49.92
Rate for Payer: Bisbee Police All Plans	$81.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$212.16
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cigna of AZ Commercial	$202.80
Rate for Payer: Copperpoint Commercial	$77.22
Rate for Payer: Health Net of AZ Commercial	$187.20
Rate for Payer: Health Net of AZ Medicare	$87.36
Rate for Payer: Humana of AZ Medicare	$49.92
Rate for Payer: Self Pay Self Pay	$249.60
Rate for Payer: TriWest Medicare	$49.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$181.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$56.16

Alcohol Level

Facility

$312.00

Service Code	CPT 80320
Hospital Charge Code	1279592
Hospital Revenue Code	301
Min. Negotiated Rate	$81.12
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Bisbee Police All Plans	$81.12
Rate for Payer: Cash Price	$249.60
Rate for Payer: Self Pay Self Pay	$249.60

Alder Tree

Facility

$74.00

Service Code	CPT 86003
Hospital Charge Code	23168775
Hospital Revenue Code	301
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Cash Price	$59.20
Rate for Payer: Self Pay Self Pay	$59.20

Alder Tree

Facility

$74.00

Service Code	CPT 86003
Hospital Charge Code	23168775
Hospital Revenue Code	301
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Aetna of AZ Medicare	$20.72
Rate for Payer: Allwell Medicare	$11.84
Rate for Payer: Amerigroup Medicare	$11.84
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.84
Rate for Payer: Banner UC Health Medicare	$11.84
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.32
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$48.10
Rate for Payer: Copperpoint Commercial	$18.32
Rate for Payer: Health Net of AZ Commercial	$44.40
Rate for Payer: Health Net of AZ Medicare	$20.72
Rate for Payer: Humana of AZ Medicare	$11.84
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

Know your out-of-pocket cost for care.

All Charges